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The New Face Lift
Text by Wendy Schmid

The new anti-aging techniques may mean sidestepping the scalpel-permanently. When doctors realize that facial volume was the key to looking younger, the focus moved from traditional face-lifts to injectables. The ability to make early incremental changes (and stay looking good) revolutionized the industry. Well, get ready for another seismic shift. The answer to staying youthful could now lie with your own fat and teeth.

Most of us are familiar with the gradual, unpleasant results of volume loss: sunken cheeks, a droopy mouth, thin lips. But deteriorating collagen and fat aren't the only causes. Much of facial aging is caused by your teeth. ''With age, teeth wear down and the jaw recedes, shortening the distance from nose to chin,'' explains New York dentist Michael Apa. ''The face appears more hollow because it's literally collapsing.'' So if you've simply been reaching for injectables, stop. The current anti-aging thinking among doctors is to first address these fundamentals structural changes. In other words, see the dentist first, then the dermatologist. ''I've had women come to me who've had face-lifts and injectables, but it didn't fix the problem because what they really needed was their teeth done,'' says New York dentist Thomas Connelly.

With this procedure, dentists like Apa and Connelly are applying veneers (wafer-thin pieces of porcelain) to upper and lower teeth the help boost the cheeks, plump lips, and restore facial volume. ''Building out the upper sides of the teeth widens the arch and lifts the cheeks,'' says Connelly. Slightly lengthening the top front teeth with veneers can also make lips appear fuller and life the corners of the mouth by subtly pushing the lips back up and out. ''A youthful face has a three-dimensional quality and this can help maintain it,'' says Miami-and New York-based dermatologist Fredric Brandt. The overall result? A face that's more filled out. Says Apa, ''You suddenly look younger, but people don't know why.''
If it sounds unlikely that veneers could fill out your face without making it look bulky or horsey, don't worry. In this procedure, each veneer is sculpted individually to flatter your face, as opposed to creating the standard Chiclets you may have seen in the past. Small changes have a big effect. ''It takes artistry to know where to reduce or build up,'' asserts Apa. ''Adding one millimeter to the surface of the back teeth translates into three millimeters in the front of the mouth,'' which can instantly take years off your face. But choose an expert wisely; veneers can last 15 years or more. Ask to see pictures or meet a patient before signing on. Apa provides a temporary ''trial smile'' that is worn for a week and can be tweaked for best results.

If teeth are framework for your face, then collagen, fat, and muscle are the siding. One supports the other. So if you're building a dream team to tackle volume loss, consider someone who specializes in another hot face-plumping procedure: stem-cell fat transfer. This promising technology is revamping traditional fat transfer, but it's in its early stages and still not widely performed. How it works: A doctor takes fat from your lower abdomen or inner thigh and processes it, separating the stem cells from the fat and ostensibly concentrating them. When these cells and the fat are put into syringes and then injected into the muscle and fatty layer under the skin, the stem cells are thought to enhance the fat's longevity and regenerate skin.
''You really get a twofold benefit: The fat gives you instant volume and the stem cells boost collagen production,'' says New York plastic surgeon Sam Rizk, who uses the PureGraft System from Cytori Therapeutics (cleared by the FDA in January) to separate out the cells. Excited doctors also note greatly improved skin texture and color as welcome side effects. ''Stem cells may help regenerate the skin's collagen and immune cells to fight free radicals,'' adds Rizk. Long-term side effects are unknown, and this leaves some doctors like Brandt with a wait-and-see attitude. Rizk, however, feels confident that future research will back up results he's seeing in his A-list patients. ''Utilizing your own adult stem cells in a regenerative way is the new frontier of cosmetic surgery.'' The bottom line: New techniques promise you'll look younger without the risk of scars or a frozen, stretched face.

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